Breastfeeding a premature or sick baby

09 March 2016

Looking back on Little Bliss

Little Bliss magazine will celebrate its tenth anniversary in April. To mark a decade of our magazine for parents, we’ll be looking back at some of the most inspiring family stories and popular topics from our previous issues.

Issue 18, Summer 2010: Breastfeeding a premature or sick baby

Breastfeeding a new baby is one of the most natural and instinctive things a mother can do. The benefits of breastfeeding for babies, including helping their development, and protecting them from illness, are even more important in premature babies. But the choice of whether to breastfeed or not is sometimes taken out of the mothers hands. Some babies are too small at first, some mothers have to express their milk and feed it through a bottle or tube, and a small number of mothers are unable to breastfeed at all.

Malindi Johnson, 31, a full-time mum of two from Staffordshire, gave birth to her son Logan at 26 weeks gestation six years ago. She found the support from hospital staff when she gave birth was exactly what she needed to help her successfully breastfeed. Despite having a very premature baby, Malindi’s overall experience of breastfeeding was a challenging but positive one.

“I was not sure what to expect,” Malindi says. “I was reliant on the hospital staff, who told me I had to start expressing straightaway. The day after I gave birth they asked if I wanted to breastfeed. The neonatal unit was very good at encouraging me and supporting me at that time.”

It was also an anxious time for Malindi because Logan was extremely ill when he was born. She says: “There were tubes and wires everywhere, you want to do the best you can for your baby, but its not always that clear what you should do. I’d been told about the benefits of breastfeeding, in terms of weight gain and development. I desperately wanted to do whatever I could for him.”

For about eight weeks Malindi was expressing milk three times a day, before Logan was ready to feed from her. She even expressed every three hours during the night, which she says was difficult without a baby to wake her up.

“I spent lots of time double-pumping alone in a room, crying and feeling so helpless.”

Malindi continued expressing while trying to make the difficult transition to fully breastfeeding.

“Some of the nurses hinted that I would be able to go home faster if I stopped trying and moved on to bottle feeding. In hindsight I know I made the right decision.”

Just before he left the hospital at 10 weeks, Logan was fully feeding. Malindi went on to breastfeed for 14 months, with the support of her own mum, the neonatal midwife and her local health visitor.

Now six, Logan is healthy with no long term problems. Her experiences with Logan, and with her second child Lucas, three, who was also born early but didn’t need neonatal care, are what led Malindi to volunteer as an NHS peer supporter at her local neonatal unit, to help support other women who want to breastfeed.

“We didn’t have that kind of support when I was in hospital. I am trained to go and help mothers of both term and premature babies to start breastfeeding, and answer any questions they may have. Often the mothers just want someone to talk to.”

Hayley Bauer, 30, a social worker from Kent, gave birth to her daughter, Olivia, at 35 weeks in April 2008. Hayley did try breastfeeding, but this turned out to be unsuccessful for a variety of reasons.

Hayley suffered from pre-eclampsia during her pregnancy and Olivia was born by emergency caesarean. Hayley was keen to try breastfeeding, but from birth Olivia struggled to suck, and had to be tube fed.

“It was impossible to have any contact with her for the first five days; she was in an incubator and was too fragile to be handled much.”Hayley began expressing milk to be put down the tube, with a view to moving on to breastfeeding later on, but a few days in she contracted a stomach virus, and had to stay away from the hospital for three days.

It was an emotional time for Hayley, as she felt under pressure to do something she knew deep down just wasn’t on the cards. After five days, the staff tried to take Olivia’s tube out and bottle feed her.

“They would spend 30 minutes trying to bottle feed and then would pour the rest down the tube. In that situation, the baby becomes the patient, and the focus is on feeding regularly to help them gain weight. The quality of bonding and parenting, and the mother’s own emotions, sort of come second to that.”

Hayley carried on trying to express milk until she and Olivia came home after five weeks. Once they were home, without an electric breast pump she found it was “useless” trying to continue.

Hayley panicked that Olivia wasn’t gaining enough weight from expressed milk, and so she switched to using formula – although as an additional complication it quickly became evident that Olivia was lactose intolerant.

Olivia, now two, has had a few physical development problems since birth, and is still very small. “There are some year old babies who weigh the same, but Olivia is quite tall, and she hasn’t had any emotional problems.”

Whilst Hayley did feel that in the short term, not being able to breastfeed Olivia did delay their bonding process, she feels that there has been no long-term difference in their relationship.

Hayley adds: “Don’t put pressure on yourself, it’s a choice. But if you do want to try, you do need to be vocal with the staff, and exercise your right to feed your child how and when you want.”

Liza Taylor, 38 from London, struggled to access the support and advice she needed from medical staff when she gave birth to her daughter Lulu at 27 weeks.

Nevertheless, with persistence and after doing her own research, Liza managed to successfully breastfeed Lulu by the time she was discharged from hospital.

“We had some warning that Lulu would arrive early, and the thought of not being able to breastfeed was one of the things that most upset me when we were told she would be born before 30 weeks. I didn’t even know if breastfeeding such a small baby was even possible,” says Liza.

“I spoke to a friend who had her son at 26 weeks, and the first thing she told me was ‘you can do it’. She’d had a very rough time whilst trying to breastfeed her son, so I found her support and encouragement really helpful.

“I also found the Bliss leaflet, and a book a friend gave me from the US, invaluable. The Bliss leaflet was not made available in the hospitals I was in, but I found it on the internet. At the time there was really very little good information out there.”

Lulu was born in Queen Charlotte’s Hospital, London, which Liza says had a very good infant feeding reputation, but when she was then transferred to her district hospital, she found that such support was lacking. “I was healthy, and I had some good information, so I wanted to try to breastfeed.

“The hospital Lulu was born at promoted Kangaroo Care, which I found really helped to get the milk supply going. It also meant that I had the confidence to ask for skin-to-skin contact in the second hospital.”

Liza successfully managed to stimulate her milk production and began expressing milk for Lulu. Although she worried about making the transition from expressing into a machine to actually breastfeeding, she never considered stopping.

For all her efforts, Liza had a positive outcome; Lulu went on to breastfeed for over a year. “Eventually I realised she was showing all the signs that she was gaining weight well, and realised I should stop being anxious.

“In a way breastfeeding is one of the things I’m proudest of as a mother. I couldn’t carry her to term but I did the best thing I could for her.”All three mums agree that whatever progress you make, however small an amount of milk you can express, or however short a period you are able to breastfeed for, you will be doing your very best for your new baby.

Malindi says: “Whatever you can do, for as long as you can do it, will benefit your baby. If you have even the slightest inclination to try to feed, do it.” Hayley agrees but stresses that “you mustn’t put too much pressure on yourself – it’s a delicate situation”, while Liza adds: “The most important message is: you can do this.”

Breastfeeding: step by step

Premature babies who have breathing difficulties may need to be fed through a drip initially, and then progress to tube feeds. You should therefore start to express your milk as soon as possible

If possible, once your baby is stable, you should practise Kangaroo Care, which means having as much skin-to-skin contact as possible, as this can help boost milk production and stimulate your immune system to produce more antibodies which will be passed on to your baby in the milk

Premature babies may not be ready to feed directly from the breast straight away, but you can express milk from your breasts by hand, or by using an electric or hand pump

It is best to express milk at least every three hours during the day, and every five to six hours at night

Double-pumping from both breasts at the same time can save a lot of time and may increase the milk supply, especially if your baby is born very early

When you are ready to try directly feeding from the breast, you can try expressing a little milk directly into your baby’s mouth to encourage them to feed; using a breast pump briefly before a feed will also help the milk flow and help your baby to latch on to the breast – be sure to have lots of skin contact as well